New research was presented at AAPM 2015, the annual meeting of the American Academy of Pain Medicine, from March 19 to 22 in National Harbor, MD. The features below highlight some of the studies that emerged from the conference. Perception of Being a Burden & Suicidality The Particulars: Few studies have assessed whether the perception of being a burden is associated with suicidality in acute and chronic pain patients. Data Breakdown: American researchers conducted a study to compare community people without pain, acute pain patients, and chronic pain patients for affirmation of being a burden. Affirmation of the perception of being a burden was used in hierarchical regression models to predict five suicide questions regarding current passive and active suicide ideation, preference for death over disability, current suicide plan, and history of suicide attempts. Patients with chronic pain and those with acute pain were most likely to perceive themselves as being a burden. Affirmation of the perception of being a burden statistically significantly predicted each of the five suicidality questions in both groups of pain patients. Take Home Pearl: Among patients with either acute or chronic pain, the perception of being a burden appears to be associated with all forms of suicidality. Psychosocial & Functional Outcomes in Low Back Pain Patients The Particulars: Patients with chronic low back pain have reported psychosocial and functional impairments as a result of their pain in multiple studies. However, the relationship between these two types of outcomes has not been well defined in this patient population. Data Breakdown: Patients with chronic low back pain who participated in a study completed anxiety, disability, pain,...

Any physician, especially primary care physicians, can tell you that they are frequently forced to make a decision based on a third party’s opinion. Most often, this will be an insurance company denying a prescribed medication or test; the discussion in the exam room evolves into a discussion of what is covered by the patient’s health plan—and what is not. The goal of providing the best medical care is often overruled by some of those decisions. Of course, the insurance company will tell you that they are not making medical decisions, and the patient can pay out of pocket if they would still like the medication or the diagnostic test. Most patients will chose to go with what their plan covers, either for financial reasons, or they feel they are paying an insurance premium, and their insurer should be paying for their medical care. All too often, I find myself playing the appeals game with the insurance companies in order to get appropriate care for my patients. For example, I recently saw a young asthmatic patient who was controlled on a certain inhaler for many years. They had tried others, but those had all failed to relieve the asthmatic symptoms. The insurance company decided that the patient would have to fail on a trial of one of the inhalers they had already failed on in the past before covering the current inhaler. Well, patients can end up in the ER or even die from an exacerbation of asthma. Clearly, this was not in the patient’s best interest. Why should third parties not be allowed in the exam room? *...

The American Headache Society (AHS) recently joined the Choosing Wisely initiative of the American Board of Internal Medicine in an effort to draw attention to tests and procedures that are associated with low-value care in headache medicine. An AHS committee of headache specialists produced a list of five such tests and treatments, and their methods and rationale were published in Headache. “We wanted the list to address common but often unnecessary or potentially risky tests and treatments for headache that in many cases do not represent evidence-based strategies,” explains Elizabeth W. Loder, MD, MPH, FAHS, who was lead author of the study. Imaging According to the AHS, neuroimaging studies should not be performed in patients with stable headaches who meet criteria for migraine. In addition, CT scans should not be used in non-emergency situations as a diagnostic tool for headache patients when MRI is available. “MRIs can diagnose more underlying conditions that may cause headache that can otherwise be missed with CT,” says Dr. Loder. In addition, MRIs do not expose patients to radiation like CT scans. The recommendations note that MRI is of better value and safer than CT for migraineurs in all but a few emergency situations. Treatments The AHS also recommends against prescribing opioid or butalbital-containing medications as first-line treatment for recurrent headache disorders. “The effectiveness of opioids is not in question,” Dr. Loder explains, “but these agents pose serious long-term risks and should be reserved for select patients. Effective long-term treatments will, in most cases, be necessary to manage this chronic disorder.” In addition, the risk of dependency and abuse associated with opioid or butalbital-containing...